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Commercial disinfectants classified as fungicides may not be effective against commonly encountered fungi within reasonable periods. Cell suspensions of clinical fungal isolates were exposed to use-dilutions of various disinfectants. Quaternary ammonium compounds, iodophors, and phenolics were not fungicidal against all test fungi within 60 min of exposure. Trichophyton mentagrophytes, Epidermophyton floccosum, and Aspergillus fumigatus were among the more resistant fungi. Disinfectants that possess low-level activity should not be used for disinfection of medical instruments that come in contact with the patient. The only reliable and safe measure is to use high-level disinfectants such as the glutaraldehydes, which are fungicidal in 15 to 30 min.
Methicillin-Resistant Staphylococcus aureus Endocarditis from a Diabetic Foot Ulcer
Understanding and Mitigating the Risk
Diabetic foot infections are a common cause of morbidity and mortality in the United States, and successful treatment often requires an aggressive and prolonged approach. Recent work has elucidated the importance of appropriate therapy for a given severity of diabetic foot infection, and highlighted the ongoing risk such patients have for subsequent invasive life-threatening infection should diabetic foot ulcers fail to heal. The authors describe the case of a man with diabetes who had prolonged, delayed healing of a diabetic foot ulcer. The ulcer subsequently became infected by methicillin-resistant Staphylococcus aureus (MRSA). The infection was treated conservatively with oral therapy and minimal debridement. Several months later, he experienced MRSA bloodstream infection and complicating endocarditis. The case highlights the ongoing risk faced by patients when diabetic foot ulcers do not heal promptly, and emphasizes the need for aggressive therapy to promote rapid healing and eradication of MRSA.
Immigration Brings New Pathology with No Standardized Treatment Protocol
Madura Foot Case Studies Phialemonium and Phaeoacremonium
Madura foot is an uncommon invasive soft-tissue infection that foot and ankle specialists encounter. We present two rare cases of Phialemonium and Phaeoacremonium fungi infections of the foot diagnosed in northern California to inform physicians on the presentation and current treatment options for this unique pathology. The two cases presented outline the clinical presentations, diagnostic data, and surgical and antimicrobial interventions. There is a concentration on the antimicrobial options depending on which of the over 20 species is encountered. The pertinent literature and supporting data are reviewed to create an outline for discussion of treatment protocols when faced with these emerging opportunistic infections.
